D1. 31/5/06: STATEMENT BY HIS EXCELLENCY MR. FESTUS G. MOGAE, PRESIDENT OF THE REPUBLIC OF BOTSWANA, AT A PANEL DISCUSSION ON "BREAKING THE CYCLE OF HIV INFECTION FOR SUSTAINABLE AIDS RESPONSES", AT THE UNITED NATIONS GENERAL ASSEMBLY HIGH LEVEL SESSION ON HIV/AIDS, NEW YORK 1. Mrs. Sheila Sisuku, Deputy Executive Director of the United Nations World Food Programme, thank you for the introduction and your kind words. Ladies and gentlemen good, afternoon! 2. I am pleased that HIV/AIDS is now firmly on the global political agenda. I, in particular, welcome the fact that today we are meeting here as the international community to focus on how we can break the cycle of HIV infection for sustainable AIDS responses. 3. We have all noted that HIV infections have reached unsustainable levels; and yet new infections are occurring at alarming rates. We also note that, in view of these rates, the current levels of the response are inadequate. They are not enough to stop the epidemic, let alone reverse it, hence, the need for this discussion. 4. I agree that, "Breaking the cycle of HIV infection for sustainable AIDS responses" is one of the key answers. But perhaps the logical question in this respect would be how to break this cycle. 5. To answer such a question, in my view, we need first to ensure that we understand the nature of the epidemic. That is, whether it is a generalised epidemic or it is only specific to some population groups. This might assist us to understand its principal modes of transmission, and to further appreciate what essentially drives or fuels the spread of the epidemic. 6. In addition, it may also be important to appreciate other dimensions of the epidemic at hand. One such is to recognise that in any epidemic, there are likely to be diverse epidemics, which are important in themselves. Usually they are a consequence of particular vulnerabilities in different sectors of the population, peculiar to a given setting. It may be critical that we understand and appreciate these dimensions, if our responses are to be relevant. How we tackle them may be key to the question at hand. 7. Some epidemics mostly manifest themselves in, among other dimensions, more infection among women and girls than their male counterparts (gender inequality); among youth, drug users, commercial sex workers, groups of particular sexual orientations, and so on. Other dimensions may include sub-national disparities (e.g. rural/urban, etc.) in infection rates, which may in fact suggest the influence of deeply rooted factors, such as culture and tradition. 8. What I have said more or less defines part of the necessary environment required for an effective response. However, the bottom line in breaking the cycle is to stop transmission of new infections to the uninfected by the infected; and to stop re-infections amongst the infected. How we do this is the question. I wish to offer the following suggestions based on my experiences. 10. People have to "know their HIV status". It is only through testing that people can know their status. One strategy is to offer voluntary counselling and testing services. 11. In Botswana we have introduced routine HIV testing in public health facilities to complement the Voluntary Counselling and Testing (VCT) services. Patients are routinely offered testing or they can request for a test when they are consulted. It has been effective; and the people have embraced it; despite earlier concerns on human rights by some of us. Depending on the setting, I would recommend it. 12. Knowing one's HIV status empowers in many ways. People who are HIV negative are empowered to adopt no or low-risk behaviour to remain negative for life. Most often, there are very few or no prevention programmes for these people. It is critical that we develop and apply such programmes. 13. On the other hand, those who are HIV positive need to live positively and not spread the virus. This includes preventing re-infection, lest other strains develop, which may be resistant to available treatment, possibly creating a new epidemic. 14. Knowing one's status also opens other opportunities. It is a gateway to treatment and support services. It also contributes towards reducing stigma and discrimination, as more and more people know and disclose their status. 15. It is also important that we provide treatment to save the lives of those who are infected. There is evidence that availability of treatment also serves to motivate uptake of other preventive programmes, such as Prevention from Mother to Child Transmission (PMTCT) and testing. In most settings, including in Botswana, without treatment most people were reluctant to know their HIV status. 16. This clearly demonstrates that prevention and treatment are closely interlinked. Both are required to sustain the intensity of prevention efforts for reducing the rate of new infections, thus breaking the cycle. 17. It is estimated that treatment, through the prevention of mother-to-child transmission, has achieved a reduction in the rate of transmission from 40% in 2002 to 6% in 2006. All expectant mothers who test HIV positive must enrol in this programme. However, there is still concern about instances of pregnancy of women who are on ARV treatment. 18.We need to guard against the pitfalls that may accompany successful roll out of treatment. We certainly must avoid a situation in which as treatment access expands, increases in risky behaviours occur, while resource commitment to and visibility of prevention programmes diminish. 19. We also need to intensify the development and implementation of new interventions and technologies. Prevention is critical in all our interventions. Without strong and accessible prevention interventions, treatment will continually increase, making the response unsustainable. 20. One of the greatest difficulties we face is the fact that the defeat of the virus depends on us as individuals. Governments alone, civil society organisations nor the international community cannot defeat the virus. We have reached the crossroads; and must decide whether we are going to be part of the problem or the solution. 21. I conclude by emphasizing the fact that every response requires resources. We should thus not tire from mobilising sufficient resources, and honour our pledges and commitments. 22. We need to also maintain, strengthen and expand partnerships in this ongoing fight against HIV/AIDS. This is a war we may have to fight for another generation. We must therefore be prepared for the 'long haul.' Thank you.